LTSS Service Coordinator - RN Clinician

Elevance Health•Wichita Falls, TX

1d•Hybrid

About The Position

The LTSS Service Coordinator RN Clinician is responsible for the overall management of a member's case within the scope of their RN licensure. This role involves providing supervision and direction to non-RN clinicians involved in the member's care, adhering to state laws and contract requirements. The primary duties include developing, monitoring, evaluating, and revising the member's care plan to meet their needs, with the ultimate goal of optimizing their healthcare across the entire care continuum. This position requires performing face-to-face clinical assessments to identify, evaluate, coordinate, and manage member needs, encompassing physical health, behavioral health, social services, and long-term services and supports.

Requirements

Requires an RN and a minimum of 3 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role; or any combination of education and experience which would provide an equivalent background.
Current, unrestricted RN license in applicable state(s) required.
May require state-specified certification based on state law and/or contract.
Must reside in Lubbock, Hale, Wilbarger, Potter, Randall, and Wichita counties in Texas.
Must be open to travel up to 1 hour away daily.

Nice To Haves

MA/MS in Health/Nursing preferred.
Travels to worksite and other locations as necessary.

Responsibilities

Identifies members at high risk for complications and coordinates care with the member and the healthcare team.
Manages members with chronic illnesses, co-morbidities, and/or disabilities to ensure cost-effective and efficient utilization of health benefits.
Obtains a thorough and accurate member history to develop an individual care plan.
Establishes short and long-term goals in collaboration with the member, caregivers, family, natural supports, and physicians.
Identifies members who would benefit from an alternative level of care or other waiver programs.
Develops the care plan for member services and ensures the member's access to those services.
May assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within the benefits structure or through extra-contractual arrangements.
Interfaces with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams on the development of care management treatment plans.
May also assist in problem-solving with providers, claims, or service issues.
Directs and/or supervises the work of any LPN/LVN, LSW, LCSW, LMSW, and other licensed professionals other than an RN, in coordinating services for the member.
Assigns appropriate tasks to non-RN clinicians, verifies and interprets member information obtained by these individuals, conducts additional assessments as necessary, and reviews and provides input on the non-RN clinicians' performance on a regular basis.